Release from Prison-A High Risk of Death for Former Inmates

Puget Sound Veterans Affairs Medical Center, Seattle, USA.
New England Journal of Medicine (Impact Factor: 55.87). 02/2007; 356(2):157-65. DOI: 10.1056/NEJMsa064115
Source: PubMed


The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons.
We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race.
Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide.
Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.

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    • "Chronic medical and mental health issues prevalent among recently released individuals include substance use disorders (SUDs), Hepatitis C, HIV, diabetes, sexually transmitted infections (STIs), cancer, suicide, and cardiovascular disease (Binswanger, Krueger, and Steiner 2009; Mallik-Kane and Visher 2005). Moreover, the risk of mortality from drug overdose and other causes in the first two weeks following release from incarceration is 129 or 12.7 times greater, respectively, than that of the general population (Binswanger et al. 2007). "
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    ABSTRACT: Background: Re-entry community health workers (CHWs) are individuals who connect diverse community residents at risk for chronic health issues such as Hepatitis C virus and cardiovascular disease with post-prison healthcare and re-entry services. While the utilization of CHWs has been documented in other marginalized populations, there is little knowledge surrounding the work of re-entry CHWs with individuals released from incarceration. Specifically, CHWs' experiences and perceptions of the uniqueness of their efforts to link individuals to healthcare have not been documented systematically. This study explored what is meaningful to formerly incarcerated CHWs as they work with released individuals. Methods: The authors conducted a qualitative thematic analysis of twelve meaningful experiences written by re-entry CHWs employed by the Transitions Clinic Network who attended a CHW training program during a conference in San Francisco, CA. Study participants were encouraged to recount meaningful CHW experiences and motivations for working with re-entry populations in a manner consistent with journal-based qualitative analysis techniques. Narratives were coded using an iterative process and subsequently organized according to themes in ATLAS.ti. Study personnel came to consensus with coding and major themes. Results: The narratives highlighted thought processes and meaning related to re-entry CHWs' work helping patients navigate complex social services for successful re-integration. Six major themes emerged from the analysis: advocacy and support, empathy relating to a personal history of incarceration, giving back, professional satisfaction and responsibilities, resiliency and educational advancement, and experiences of social inequities related to race. Re-entry CHWs described former incarceration, employment, and social justice as sources of meaning for assisting justice-involved individuals receive effective, efficient, and high-quality healthcare. Conclusions: Health clinics for individuals released from incarceration provide a unique setting that links high risk patients to needed care and professionalizes career opportunities for formerly incarcerated re-entry CHWs. The commonality of past correctional involvement is a strong indicator of the meaning and perceived effectiveness re-entry CHWs find in working with individuals leaving prison. Expansion of reimbursable visits with re-entry CHWs in transitions clinics designed for re-entering individuals is worthy of further consideration.
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    • "Moreover, former prisoners have higher mortality rates than the general population. Female ex-prisoners, for example, have higher rates of death than male ex-prisoners, though both male and female ex-prisoners have mortality rates that are, on average, 3.5 times higher than that of the general population (Binswanger et al., 2007). All said, it is not surprising that incarceration is linked to deleterious effects on individual and population health (Auchincloss et al., 2008; Spaulding et al., 2011; Thomas, 2006; Wildeman, 2011; Wildeman, 2012; for an exception, see Akers et al., 2012; Potter, 2007). "
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    ABSTRACT: Studies show that ex-prisoners often experience more health problems than the general population; unfortunately, these issues follow them upon their release from prison. As such, it is possible re-entry rates signal the need for neighborhood-based health care organizations (HCOs). We ask: are incarceration and re-entry rates associated with the availability of HCOs?. Methods Using 2008 Central Business Pattern data, 2008 prison admissions and release data, and 2000 and 2010 census data, we test whether prison admission and release rates impact the availability of HCOs net of neighborhood characteristics in Arkansas using Logit-Poisson hurdle models with county fixed effects. We find that the incarceration and re-entry rates – together known as coercive mobility -- are related to whether a neighborhood has one or more HCOs, but not to the number of HCOs in a neighborhood. Future public policies should aim to locate health care organizations in areas where there is significant churning of individuals in and out of prison.
    Full-text · Article · Dec 2015
    • "In Australia, the odds of psychiatric illness are 10 times greater in prisoners than the wider population (Butler et al. 2006). After release, former prisoners continue to be at dramatically elevated risk of adverse mental health outcomes (Alan et al. 2011; Frank et al. 2013) and suicide (Binswanger et al. 2007; Spittal et al. 2014). Ex-prisoners with a history of mental disorder are at even greater risk than other ex-prisoners for a host of poor outcomes, including substance misuse, homelessness, unemployment (Cutcher et al. 2014), reincarceration (Baillargeon et al. 2009) and mortality from drug overdose and suicide (Kariminia et al. 2007; Webb et al. 2011). "
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    ABSTRACT: Background: Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community. Method: The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage. Results: We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours. Conclusions: For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.
    No preview · Article · Nov 2015 · Psychological Medicine
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